New Cochrane evidence provides no definitive recommendation on the best way to treat severe nausea and vomiting in early pregnancy
Nausea and vomiting in early pregnancy are very common, affecting approximately 80% of pregnancies. Hyperemesis gravidarum (HG), a severe form affecting only about 1.0% of pregnancies worldwide, generally includes intractable nausea/vomiting, signs of dehydration, electrolyte imbalances, and weight loss, excluding other diagnoses. The onset is generally in the first trimester, peaking by 12 weeks, with most women having resolution of symptoms by 20 weeks.
HG is debilitating and worrying for women, and the leading cause of hospital admissions in pregnancy. The socio-economic costs of hyperemesis are also significant, stemming from treatment expense, lost job productivity, and high healthcare costs.
This is the first Cochrane Review on treating HG, focusing specifically on trials of interventions for severe nausea and vomiting in pregnancy. A team of authors based in Italy, the UK, and the US and working with the Cochrane Pregnancy and Childbirth Group assessed 25 studies involving 2052 women and examining 18 different comparisons of interventions, including acupressure/acupuncture, outpatient care, intravenous fluids, and various commonly used anti-sickness drugs. They concluded that there was little evidence to support the superiority of any one intervention over another, which is useful to know for those making decisions about managing the condition.